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PubMed2006

Financial indicators for critical access hospitals.

CONTEXT: There is a growing recognition of the need to measure and report hospital financial performance. However, there exists little comparative financial indicator data specifically for critical access hospitals (CAHs). CAHs differ from other hospitals on a number of dimensions that might affect appropriate indicators of performance, including differences in Medicare reimbursement, limits on bed size and average length of stay, and relaxed staffing rules. PURPOSE: To develop comparative financial indicators specifically designed for CAHs using Medicare cost report data. METHODS: A technical advisory group of individuals with extensive experience in rural hospital finance and operations provided advice to a research team from the University of North Carolina at Chapel Hill. Twenty indicators deemed appropriate for assessment of CAH financial condition were chosen and formulas determined. Issues 1 and 2 of the CAH Financial Indicators Report were mailed to the chief executive officers of 853 CAHs in the summer of 2004 and 1,092 CAHs in the summer of 2005, respectively. Each report included indicator values specifically for their CAH, indicator medians for peer groups, and an evaluation form. FINDINGS: Chief executive officers found the indicators to be useful and the underlying formulas to be appropriate. The multiple years of data provide snapshots of the industry as a whole, rather than trend data for a constant set of hospitals. CONCLUSIONS: The CAH Financial Indicators Report is a useful first step toward comparative financial indicators for CAHs.

Benchmarking↗
PubMed2005

Injury outcome indicators: the development of a validation tool.

BACKGROUND: Researchers have previously expressed concern about some national indicators of injury incidence and have argued that indicators should be validated before their introduction. AIMS: To develop a tool to assess the validity of indicators of injury incidence and to carry out initial testing of the tool to explore consistency on application. METHODS: Previously proposed criteria were shared for comment with members of the International Collaborative Effort on Injury Statistics (ICE) Injury Indicators Group over a period of six months. Immediately after, at a meeting of Injury ICE in Washington, DC in April 2001, revised criteria were agreed over two days of meetings. The criteria were applied, by three raters, to six non-fatal indicators that underpin the national road safety targets for Canada, New Zealand, and the United Kingdom. Consistency of ratings were judged. CONSENSUS OUTCOME: The development process resulted in a validation tool that comprised criteria relating to: (1) case definition, (2) a focus on serious injury, (3) unbiased case ascertainment, (4) source data for the indicator being representative of the target population, (5) availability of data to generate the indicator, and (6) the existence of a full written specification for the indicator. On application of these criteria to the six road safety indicators, some problems of agreement between raters were identified. CONCLUSION: This paper has presented an early step in the development of a tool for validating injury indicators, as well as some directions that can be taken in its further development.

Accidents, Traffic↗
PubMed2003

Quality indicators for primary care mental health services.

OBJECTIVES: To identify a generic set of face valid quality indicators for primary care mental health services which reflect a multi-stakeholder perspective and can be used for facilitating quality improvement. DESIGN: Modified two-round postal Delphi questionnaire. SETTING: Geographical spread across Great Britain. PARTICIPANTS: One hundred and fifteen panellists representing 11 different stakeholder groups within primary care mental health services (clinical psychologist, health and social care commissioner, community psychiatric nurse, counsellor, general practitioner, practice nurse/district nurse/health visitor, psychiatrist, social worker, carer, patient and voluntary organisations). MAIN OUTCOME MEASURES: Face validity (median rating of 8 or 9 on a nine point scale with agreement by all panels) for assessing quality of care. RESULTS: A maximum of 334 indicators were rated by panels in the second round; 26% were rated valid by all panels. These indicators were categorised into 21 aspects of care, 11 relating to general practices and 10 relating to health authorities or primary care groups/trusts. There was variation in the total number of indicators rated valid across the different panels. Overall, GPs rated the lowest number of indicators as valid (41%, n=138) and carers rated the highest number valid (91%, n=304). CONCLUSIONS: The quality indicators represent consensus among key stakeholder groups in defining quality of care within primary care mental health services. These indicators could provide a guide for primary care organisations embarking on quality improvement initiatives in mental health care when addressing national targets and standards relating to primary care set out in the National Service Framework for Mental Health for England. Although many of the indicators relate to parochial issues in UK service delivery, the methodology used in the development of the indicators could be applied in other settings to produce locally relevant indicators.

Attitude of Health Personnel↗
PubMed2004

Developing quality indicators for older adults: transfer from the USA to the UK is feasible.

BACKGROUND: Measurement of the quality of health care is essential for quality improvement, and patients are an underused source of data about quality of care. We describe the adaptation of a set of USA quality indicators for use in patient interview surveys in England, to measure the extent to which older patients receive a broad range of effective health care interventions in both primary and secondary care. METHOD: One hundred and nineteen quality indicators covering 16 clinical areas, based on a set of indicators for the care of vulnerable elderly patients in the USA, were reviewed by a panel of 10 clinical experts in England. A modified version of the RAND/UCLA appropriateness method was used and panel members were supplied with literature reviews summarising the evidence base for each quality indicator. The indicators were sent for comment before the panel meeting to UK charitable organisations for older people. RESULTS: The panel rated 102 of the 119 indicators (86%) as valid for use in England; 17 (14%) were rejected as invalid. All 58 indicators about treatment or continuity and follow up were rated as valid compared with just over half (13 of 24) of the indicators about screening. CONCLUSIONS: These 102 indicators are suitable for use in patient interview surveys, including the English Longitudinal Study of Ageing (ELSA). The systematic measurement of quality of care at the population level and identification of gaps in quality is essential for quality improvement. There is potential for transfer of quality indicators between countries, at least for the health care of older people.

Aged↗
PubMed2004

Are diagnosis specific outcome indicators based on administrative data useful in assessing quality of hospital care?

BACKGROUND: Hospital performance reports based on administrative data should distinguish differences in quality of care between hospitals from case mix related variation and random error effects. A study was undertaken to determine which of 12 diagnosis-outcome indicators measured across all hospitals in one state had significant risk adjusted systematic (or special cause) variation (SV) suggesting differences in quality of care. For those that did, we determined whether SV persists within hospital peer groups, whether indicator results correlate at the individual hospital level, and how many adverse outcomes would be avoided if all hospitals achieved indicator values equal to the best performing 20% of hospitals. METHODS: All patients admitted during a 12 month period to 180 acute care hospitals in Queensland, Australia with heart failure (n = 5745), acute myocardial infarction (AMI) (n = 3427), or stroke (n = 2955) were entered into the study. Outcomes comprised in-hospital deaths, long hospital stays, and 30 day readmissions. Regression models produced standardised, risk adjusted diagnosis specific outcome event ratios for each hospital. Systematic and random variation in ratio distributions for each indicator were then apportioned using hierarchical statistical models. RESULTS: Only five of 12 (42%) diagnosis-outcome indicators showed significant SV across all hospitals (long stays and same diagnosis readmissions for heart failure; in-hospital deaths and same diagnosis readmissions for AMI; and in-hospital deaths for stroke). Significant SV was only seen for two indicators within hospital peer groups (same diagnosis readmissions for heart failure in tertiary hospitals and inhospital mortality for AMI in community hospitals). Only two pairs of indicators showed significant correlation. If all hospitals emulated the best performers, at least 20% of AMI and stroke deaths, heart failure long stays, and heart failure and AMI readmissions could be avoided. CONCLUSIONS: Diagnosis-outcome indicators based on administrative data require validation as markers of significant risk adjusted SV. Validated indicators allow quantification of realisable outcome benefits if all hospitals achieved best performer levels. The overall level of quality of care within single institutions cannot be inferred from the results of one or a few indicators.

Cohort Studies↗
PubMed2003

Healthy workplace indicators in Thailand: phase 2 (a pilot study).

This study was a result of the second phase of a two-phase research project. In the previous phase, the draft of healthy workplace indicators was developed by means of literature review and soliciting of expert opinion. There were 46 indicators divided into 6 different groups. This phase of the project was a quantitative cross-sectional descriptive study which aimed at exploring the opinion of employers and occupational health officers (OHOs) of the enterprises towards the pilot set of healthy workplace indicators. The field data collection was conducted by means of a postal survey. Questionnaires were sent to 180 workplaces in Samutprakarn province. The response rates of employers and OHOs were 66.7 per cent (n = 120) and 68.3 per cent (n = 123), respectively. It was found that the majority of the enterprises had a workplace health promotion policy (59.3%), had health promotion activities (60.2%), did not have designated personnel responsible for health promotion (69.1%), had a health promotion budget (53.7%), were large scale enterprises (61.0%), and did not have a mother enterprise in foreign country (81.3%). In general, the mean scores of the opinions of employers and OHOs toward indicators in the appropriateness aspect were high. For the achievability aspect, there were 9 indicators which less than half of the employers thought they could achieve, and 10 indicators that less than half of the OHOs thought they could achieve. The opinion of employers and OHOs differed significantly in 4 indicators in the appropriateness aspect and 1 indicator in the achievability aspect. In conclusion, both the employers and OHOs considered most of these indicators appropriate for the enterprises and most indicators were achievable and useful as a guideline and evaluation tool for workplace health promotion.

Adult↗
PubMed2006

Survey of Poincaré indices for measuring heart rate variability.

Multiple indices have been developed to characterise the nonperiodic behaviour of heart rate variability displayed in Poincaré plots, particularly with R-R interval data collected over 24hr periods. Some of these indices have been compared to statistical time-domain indices and some to spectral indices, while others have been used to separate data sets such as cardiac abnormalities. A survey of published indices for Poincaré plot analysis was made covering literature through the 1990's to the present day. Statistical time-domain indices and the surveyed Poincaré indices were used to analyse the same data set of R-R intervals that included: supine, standing, deep breathing, light exercise and recovery. This study examined these Poincaré indices and determined their correlations with time-domain indices, and investigated how the correlations are affected by analysing shorter time periods. Further investigation of the Poincaré indices that do not correlate strongly with SD or rMSSD may prove interesting in determining dynamic characteristics of cardiac nervous system activity.

Algorithms↗
PubMed1995

An epidemiological perspective on environmental health indicators.

There is a great amount of ongoing discussion about the need to develop new ways to assess and monitor a population's disease susceptibility to environmental factors. The ultimate goal in developing these tools, called environmental health indicators, is to increase the public health community's capacity for implementing interventions to prevent disease. Much of the discussion focuses on the requirement that the indicators be relatively easy and quick to apply. However, in the rush to find useful existing indicators, or to develop new ones, there is the danger that certain other important attributes of the indicator may be overlooked. These include: (a) whether the indicator truly represents an underlying causal relationship between an environmental exposure and a health consequence; and (b) whether the proposed indicator is a reasonably valid estimate of the underlying causal factor. This article provides a framework for relating environmental health indicators to the methods of epidemiology including some guidance for selecting and evaluating the appropriateness of proposed environmental health indicators. Examples are given which demonstrate how environmental health indicators can lead to a biased interpretation of underlying associations between environmental factors and the potential for disease when they are improperly conceived. These problems can be avoided by employing routine epidemiological concepts and methods as indicators are developed and evaluated.

Adult↗
PubMed1995

Dental health indicator based on a questionnaire.

Dentistry has lacked an effective indicator of the impact of dental problems on a person's daily life. Subjective factors in dental health need to be included in order to improve current indicators. The purpose of this research was to develop a new type of indicator recorded from a questionnaire which takes account of subjective factors in dental health. The indicator we constructed has the following advantages. 1. Calculation process is simple in practice. 2. The indicator values range from 0 to 100, with values closer to 100 indicating a more favorable condition for the individual. 3. The distribution of indicator values is similar to the normal distribution. 4. The score of each item is reflected on the indicator, suggesting the individual's characteristics in terms of dental health. 5. Although it is principally an indicator for individuals, it can also be applied to groups. This study will also provide a model for the preparation of a dental health indicator.

Adult↗
PubMed1999

Brachial and crural indices of European late Upper Paleolithic and Mesolithic humans.

Among recent humans brachial and crural indices are positively correlated with mean annual temperature, such that high indices are found in tropical groups. However, despite inhabiting glacial Europe, the Upper Paleolithic Europeans possessed high indices, prompting Trinkaus (1981) to argue for gene flow from warmer regions associated with modern human emergence in Europe. In contrast, Frayer et al. (1993) point out that Late Upper Paleolithic and Mesolithic Europeans should not exhibit tropically-adapted limb proportions, since, even assuming replacement, their ancestors had experienced cold stress in glacial Europe for at least 12 millennia. This study investigates three questions tied to the brachial and crural indices among Late Pleistocene and recent humans. First, which limb segments (either proximal or distal) are primarily responsible for variation in brachial and crural indices? Second, are these indices reflective of overall limb elongation? And finally, do the Late Upper Paleolithic and Mesolithic Europeans retain relatively and/or absolutely long limbs? Results indicate that in the lower limb, the distal limb segment contributes most of the variability to intralimb proportions, while in the upper limb the proximal and distal limb segments appear to be equally variable. Additionally, brachial and crural indices do not appear to be a good measure of overall limb length, and thus, while the Late Upper Paleolithic and Mesolithic humans have significantly higher (i.e., tropically-adapted) brachial and crural indices than do recent Europeans, they also have shorter (i.e., cold-adapted) limbs. The somewhat paradoxical retention of "tropical" indices in the context of more "cold-adapted" limb length is best explained as evidence for Replacement in the European Late Pleistocene, followed by gradual cold adaptation in glacial Europe.

Animals↗
PubMed2001

Indicators for transboundary river management.

The aim of this paper is to analyze the potential of indicators for integrated river basin management and to develop a set of indicators for the management of transboundary river basins. An indicator, comprising a variable or some aggregation of variables, describes a system or process such that it has significance beyond the face value of its components. Integrated river basin management takes into account policies and measures for the multifunctional use of rivers on a catchment scale and associated institutional changes. Indicators are useful instruments for this process for two reasons. Firstly, they meet the information need of policy- and decision-makers. Secondly, indicators can be used to structure the definition and description of information needs and collection of information between the different international, institutional, and sectoral management levels. The development of indicators involves a number of steps: definition of aim, construction of conceptual model, selection of variables, comparison with selection criteria, database assessment, and indicator selection. In this paper these steps are discussed and specified for integrated river basin management. This results in a set of indicators describing the pressure to the river, the state of the river ecosystem, the impact to goods and services provided by the river, and the societal response. The proposed set of indicators measured at a river basin scale provides integrated information on the use and supply of goods and services, underlying cause-effect relationships and possible trade-offs and their spatial distribution (e.g., upstream versus downstream). Furthermore, we propose a division of tasks and responsibilities for river basin management with regard to the development of indicators, data collection, and their application in decision-making.

Conservation of Natural Resources↗
PubMed2001

Evaluating microbial indicators of environmental condition in Oregon rivers.

Traditional bacterial indicators used in public health to assess water quality and the Biolog system were evaluated to compare their response to biological, chemical, and physical habitat indicators of stream condition both within the state of Oregon and among ecoregion aggregates (Coast Range, Willamette Valley, Cascades, and eastern Oregon). Forty-three randomly selected Oregon river sites were sampled during the summer in 1997 and 1998. The public health indicators included heterotrophic plate counts (HPC), total coliforms (TC), fecal coliforms (FC) and Escherichia coli (EC). Statewide, HPC correlated strongly with physical habitat (elevation, riparian complexity, % canopy presence, and indices of agriculture, pavement, road, pasture, and total disturbance) and chemistry (pH, dissolved O2, specific conductance, acid-neutralizing capacity, dissolved organic carbon, total N, total P, SiO2, and SO4). FC and EC were significantly correlated generally with the river chemistry indicators. TC bacteria significantly correlated with riparian complexity, road disturbance, dissolved O2, and SiO2 and FC. Analyzing the sites by ecoregion, eastern Oregon was characterized by high HPC, FC, EC, nutrient loads, and indices of human disturbance, whereas the Cascades ecoregion had correspondingly low counts of these indicators. The Coast Range and Willamette Valley presented inconsistent indicator patterns that are more difficult to characterize. Attempts to distinguish between ecoregions with the Biolog system were not successful, nor did a statistical pattern emerge between the first five principle components and the other environmental indicators. Our research suggests that some traditional public health microbial indicators may be useful in measuring the environmental condition of lotic systems.

Bacteria↗
PubMed2005

Influence of set-up conditions of exposure indicators on the estimate of short-term associations between urban pollution and mortality.

In the past few years many studies on air pollution and health based on time series have been carried out. Yet, this approach does not assess exposure to air pollution at an individual level but it is based on ambient concentrations measured by air quality monitoring networks. Questions on the estimates of exposure to pollutants have been raised, in particular the fact that background measuring stations only have been considered in the set up of pollution indicators. To assess the impact of exposure indicator characteristics on the results of time series analysis, two series (black smoke and sulfur dioxide, respectively) of exposure indicators to urban air pollution were set up taking into account a growing part of proximity measures (industrial sources) available in the studied urban area (Le Havre, France). For each pollutant, indicators distributions were almost similar, especially for black smoke. Whatever the pollutant, the most obvious heterogeneity could be observed between the 100% background indicator and the indicator including the arithmetic mean for all the stations (50% background stations and 50% proximity stations). Then the sensitivity of the associations between mortality and air pollution to these indicators was studied. These indicators did not show statistically significant differences in the estimated excess risk. Yet, confidence intervals were more statistically significant as the contribution of proximity stations was more substantial, in particular for SO2. To conclude, the use of proximity measurements did not influence dramatically on the mean estimates of the association between air pollution and mortality indicators in Le Havre. Therefore it does not seem relevant to include the data provided by the proximity stations in the urban exposure indicators within the context of the epidemiology monitoring system.

Air Pollutants↗
PubMed2001

Lake ecosystem health assessment: indicators and methods.

A set of ecological indicators including structural, functional, and system-level aspects were proposed for a lake ecosystem health assessment, according to the structural, functional, and system-level responses of lake ecosystems to chemical stresses including acidification, eutrophication and copper, oil and pesticide contamination. The structural indicators included phytoplankton cell size and biomass, zooplankton body size and biomass, species diversity, macro- and micro-zooplankton biomass, the zooplankton phytoplankton ratio, and the macrozooplankton microzooplankton ratio. The functional indicators encompassed the algal C assimilation ratio, resource use efficiency, community production, gross production/respiration (i.e. P/R) ratio, gross production standing crop biomass (i.e. P/B) ratio, and standing crop biomass unit energy flow (i.e. B/E) ratio. The ecosystem-level indicators conisisted of ecological buffer capacities, energy, and structural energy. Based on these indicators, a direct measurement method (DMM) and an ecological modeling method (EMM) for lake ecosystem health assessment were developed. The DMM procedures were designed to: (1) identify key indicators; (2) measure directly or calculate indirectly the selected indicators; and, (3) assess ecosystem health on the basis of the indicator values. The EMM procedures were designed to: (1) determine the structure and complexity of the ecological model according to the lake's ecosystem structure; (2) establish an ecological model by designing a conceptual diagram, establishing model equations, and estimating model pararmeters; (3) compare the simulated values of important state variables and process rates with actual observations; (4) calculate ecosystem health indicators using the ecological model; and, (5) assess lake ecosystem health according to the values of the ecological indicators. The results of a case study demonstrated that both methods provided similar results which corresponded with the lake's actual trophic state.

Animals↗
PubMed1997

Indications for arterial reconstruction and major amputation in the management of chronic critical lower limb ischaemia. The Scottish and Northern Vascular Audit Groups.

OBJECTIVES: The aim of this study was to derive specific clinical indications for surgery in patients with chronic critical lower limb ischaemia and to determine the extent to which practice in Scotland conformed to these indications. DESIGN, MATERIALS AND METHODS: Consensus on indications was achieved using a modified Delphi method in which a postal questionnaire was completed by 29 vascular surgeons on two occasions, with feedback between the rounds. Respondents indicated the appropriateness of arterial reconstruction and primary major amputation for 218 case scenarios comprising all possible combinations of clinical and angiographic findings. RESULTS: Agreement was reached on 31 appropriate indications for major amputation and 65 for arterial reconstruction. In 10 hospitals in Scotland, 400 primary amputation and arterial reconstruction operations were reviewed retrospectively and compared with the indications. The clinical findings for 7 (4%) arterial reconstructions and 48 (24%) major amputations did not conform to the indications agreed by the Delphi method. The proportion of operations conforming to the agreed indications differed significantly by size of unit (p < 0.025). CONCLUSIONS: This study shows that consensus can be reached on indications for surgery. However, in practice some operations performed do not conform with these indications. This discrepancy may be due to inappropriate practice.

Amputation, Surgical↗
PubMed2004

The structure of variation and its influence on the estimation of status: indicators of condition of lakes in the Northeast, U.S.A.

One goal of regional-scale sample surveys is to estimate the status of a resource of interest from a statistically drawn representative sample of that resource. An expression of status is the frequency distribution of indicator scores capturing variability of attributes of interest. However, extraneous variability interferes with the status description by introducing bias into the frequency distributions. To examine this issue, we used data from a regional survey of lakes in the Northeast U.S. collected by the U.S. Environmental Protection Agency's Environmental Monitoring and Assessment Program (EMAP). We employ a components of variance model to identify sources of extraneous variance pertinent to status descriptions of physical, chemical, and biological attributes of the population of lakes in the NE. We summarize the relative magnitude of four components of variance (lake-to-lake, year, interaction, and residual) for each indicator and illustrate how extraneous variance biases the status descriptions. We describe a procedure that removes this bias from the status descriptions to produce unbiased estimates and introduce a novel method for estimating the 'cost' of removing the bias (expressed as either increased sampling uncertainty or additional samples needed to achieve the target precision in the absence of bias). We compare the relative magnitude of the four variance components across the array of indicators, finding in general that conservative chemical indicators are least affected by extraneous variance, followed by some nonconservative indicators, with nutrient indicators most affected by extraneous variance. Intermediate were trophic condition indicators (including sediment diatoms), fish species richness and individuals indicators, and zooplankton taxa richness and individuals indicators. We found no clear patterns in the relative magnitude of variance components as a function of several methods of aggregating fish and zooplankton indicators (e.g., level of taxonomy, or species richness vs. numbers of individuals).

Analysis of Variance↗
PubMed2004

Pain assessment in intellectually disabled people: non-verbal indicators.

BACKGROUND: Although important progress has been made during the past decade, research on pain in people with intellectual disabilities is still scarce. Pain assessment in people with intellectual disabilities is a frequent and difficult problem, especially for nurses working with people with intellectual disabilities on a daily basis. Gathering more information about pain in people with intellectual disabilities is of major importance and relevance for nursing, and adds to the developing body of knowledge. OBJECTIVE: To investigate the nature and relative importance of non-verbal indicators used by nurses to assess pain in people with a severe or profound intellectual disability. METHODS: A questionnaire consisting of 158 indicators of pain was used. A total of 135 nurses from nine institutions specializing in the care of people with intellectual disability were asked to rate each indicator on a scale of 1-10 to show which non-verbal expressions they considered important in diagnosing pain. RESULTS: A total of 109 nurses responded. All 158 indicators were mentioned as being important to indicate pain. All except four had a range of 9. Seven (moaning during manipulation, crying during manipulation, painful facial expression during manipulation, swelling, screaming during manipulation, not using (affected) body part, and moving the body in a specific way of behaving) were reported as 'very important' by more than 50% of nurses. The lowest score (median 5.5; minimum 1, maximum 10) was given to the indicator 'waving arm movements'. The pain of people with severe intellectual disability appeared to be assessed differently from that of people with profound intellectual disability. Indicators belonging to the 'physiological' category scored relatively higher in the group of nurses specializing in profound disability. In contrast, indicators belonging to the 'social-emotional' category were scored relatively higher by nurses specializing in severe disability. CONCLUSION: Nurses used a wide range of indicators to assess pain in people with intellectual disability. Functional abilities and level of disability seem to influence the indicators used.

Attitude of Health Personnel↗
PubMed2006

Do ultrasound renal resistance indices reflect systemic rather than renal vascular damage in chronic kidney disease?

BACKGROUND: In patients suffering from chronic kidney disease (CKD), ultrasound renal resistance indices predict progression of kidney disease and death. Although ultrasound resistance indices were initially considered to directly reflect intrarenal vascular resistance, they are complex composite parameters that are influenced by various vascular factors. We hypothesized that renal resistance indices reflect systemic vascular disease rather than local renal damage in patients with CKD. METHODS: In 140 patients suffering from CKD not receiving renal replacement therapy, intrarenal resistance indices were measured in interlobar arteries. For assessment of systemic atherosclerotic disease, common carotid intima-media thickness (IMT) and ankle-brachial blood pressure index were determined. Categories of risk for coronary heart diseases were defined by Framingham risk scoring. RESULTS: Increased renal resistance indices were associated with high Framingham risk scores and with the presence of atherosclerotic disease. In addition, ultrasound renal resistance indices progressively increased with the stage of renal function impairment, and patients suffering from diabetic nephropathy had higher resistance indices than patients suffering from other renal diseases. In a multivariate linear regression analysis, IMT, Framingham risk score, renal function, presence of diabetic nephropathy and pulse pressure independently predicted resistance indices. However, when additionally adjusting for age, IMT and Framingham risk score were no longer independent predictors of resistance indices. CONCLUSIONS: In patients suffering from CKD, intrarenal resistance indices are independently associated with cardiovascular risk score and systemic vascular disease as well as with aetiology and stage of CKD. This may explain their strong association with both impaired renal outcome and death.

Aged↗